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October 2006 Issue

Gerry Fairbrother, PhD, and Craig Brammer are leading the UC–Cincinnati Children’s effort to improve Ohio’s Medicaid system.
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UC, Cincinnati Children's Partnering With State of Ohio to Improve Health Outcomes

Published October 2006

Nearly 2 million Ohioans count on Medicaid—a state and federally funded health care plan—for their medical coverage.

About 25 percent of Ohio’s budget is spent to support Medicaid. However, payments to physicians and other providers are rarely tied to the quality or cost effectiveness of the care they deliver.

UC and Cincinnati Children’s Hospital Medical Center are partnering with the Ohio Department of Jobs and Family Services to make sure Medicaid recipients are getting the care they need and to improve the performance of Ohio’s Medicaid program.

Like many other states and private purchasers across the country, Ohio is seeking to implement a “value-purchasing” strategy within its Medicaid system. UC and Cincinnati Children’s will use a $700,000 grant to study the effectiveness of such a plan and make recommendations for how the plan should be designed and monitored.

The study will be led by Gerry Fairbrother, PhD, professor of pediatrics at UC and member of the Center for Epidemiology and Biostatistics and the health policy and clinical effectiveness division at Cincinnati Children’s, and co-principal investigator Craig Brammer, senior research associate in UC’s Institute for the Study of Health.

“Value-purchasing strategies, including ‘pay-for-performance,’ sound like common sense to the general public because they want to know they’re getting the best care they can get,” says Fairbrother. “But to physicians who are taught to always provide the best possible care, ‘pay-for-performance’ raises concerns about how quality is measured.”

“The Ohio Medicaid program is working to provide the highest quality of care to our most vulnerable citizens—especially those with hard-to-manage chronic illnesses,” says Brammer. “By improving the health of the men, women and children served by Ohio Medicaid, we will be able to better control costs.”

The UC–Cincinnati Children’s team will first work with physicians and stakeholders across the state to design ways to monitor a series of “performance measures.”

It’s important, the researchers say, that they work with physicians to come up with the best way to implement such a plan, especially if they want a plan that addresses physicians’ concerns about reimbursements as well as the concerns of smaller medical practices that may not treat as many Medicaid patients.

The team will evaluate how often Medicaid recipients are receiving common health screenings— like mammograms or PSA tests—or medications or blood work for chronic illnesses such as asthma or diabetes.

Once strategies are in place to better monitor these performance measures, the team will design ways to rate the performance of providers caring for Medicaid patients.

“We want to help create an environment that rewards excellence,” says Fairbrother. “Ohio is really advanced in its thinking on aligning incentives with other purchasers in the state.”

“Across the board, managed care companies, Medicaid and Medicare are all doing things differently,” says Brammer. “Getting a more integrated plan in place here could serve as an example to other states and organizations as they work to implement similar strategies.”

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